Why Tuesday?

Tuesday, October 26, 2010

When I was five years old I played “doctor” with “Michael N.” in the basement of our neighbour Karen’s house. I can remember it as if it were yesterday. Actually my memory of the basement room is far more accurate than that of the activity that took place in it. There was an empty dog harness hanging from the ceiling that Karen’s father told us was an “invisible dog”. I no more believed in the validity of the dog as I did about my medical skills at the time put given that we were pretending I figured it could not help but imagine Karen’s family pet hanging from the ceiling in the basement.

I always insisted that Michael be the patient. He was 2 years my senior and I was a rather ambitious 5 year old. This made for an agreement on both our parts.

My point is that “Playing Doctor” is a ritual that I would argue many of us have done in our lifetimes. Usually it is well before the age of maturity and child behaviouralists claim it is a way in which children explore their bodies.

Michael would present with a bunch of imaginary symptoms. “Hello Dr. Ali” he would say, “I have a cough” and down we would go to Karen’s Basement aka: my exam room past the imaginary/invisible dog into our play room where I would examine Michael with a Fisher Price Doctor’s kit and diagnose him with anything my imagination could conjure at the time.

Let it be know that I never made Michael show me anything more than his underpants. One might say that even back then I was adamant that my patients preserve their dignity.

Last week I met a woman who insists on preserving her inner child. By this I mean, that at 73 years of age, she is till playing doctor. Although I suspect her office is somewhat more the likes of her den or home office and there is no invisible dog. There she sits in her living room or extra bedroom on her computer “Googling” her symptoms and waiting for the word “cancer” to appear on the screen.

She was kind enough to come to her doctor’s appointment armed with the fruits of her Google searched. I kid you not. She handed me a four-page print out of her symptoms and a cross-referenced list of what the Internet had to offer in terms of her diagnosis and her treatment.

The mind-altering thing about this experience was not THAT it happened. But that this has happened, nay happens easily once a month in any doctor’s office in any town across this great land. Safe to say that this happens to me easily once a month to some varying degree.

A population based survey out of a major pharmacy chain in the UK shows that 81% of people have researched their symptoms on the Internet and made a self-diagnosis BEFORE they ever see a doctor.

A further Australian study shows that 1 in 4 Australians use their Internet searches IN PLACE OF a doctor’s visit for self-diagnosis.

According to the 2009 Health Care in Canada Survey, 84% Canadians are online Internet users (24million). Seventy percent of Canadians have visited a health care website in past year in order to achieve a diagnosis or information about a medication or symptom.

Many online Canucks (almost 60%) are using the Internet to conduct their own self-diagnosis. Fortunately, 51% of those playing “cyber doctor” say their own diagnosis via the Internet is confirmed as correct after consultation with a doctor.

One in five Canadians say they visit their doctor less often because of information they received on the Internet.

Look, I’m a fan of the Internet. It is by far one of the greatest vehicles of information there ever was. Yah, and I can shop from the comfort of my own bed. Buying shoes while lying down? That’s genius.

But should we not draw the line somewhere? Shouldn’t you have to take some sort of medical intelligence test before you can just punch in all your symptoms on a screen and wait for the word “cancer” to pop up in response?

I do think self-diagnosis has its place. It does make patients more informed and offers them and avenue to have many of their fears alleviated. Furthermore, it provides them with a volume of resources that as a single physician I could only dream of providing.

In reality, most of the time the Internet makes my job a hell of a lot easier. People come to my office with informed questions and a place where they can often find added resources.

But then there are those extremes. Those “one in a hundred” cases where someone really uses their high-school biology powers for evil and not for good.

I’m not sure what the solution is. I’m not sure there is a solution.

All I know is as long as human beings have had a quest for knowledge we have found ourselves in some sort of curious situation in some sort of basement, trying to find the secrets of the universe.

Maybe that should be enough for me? Maybe it should be a comfort to me to know that all of this… the google searches and cross-reference lists are a sign of humanities quest for wisdom? Maybe we’re all just a bunch of six-year-olds just trying to play doctor in a world we all want to make sense of.

Maybe I’m full of shit. All I know is that I have the BEST of memories of that basement/doctor’s office so many years ago where dreams and diagnoses were made under the watchful eye of an invisible dog. And just like back then, as long as no one gets hurt, is there really any harm in pretending once in a while?

Tuesday, October 19, 2010

I was having the most lovely day on a date with myself in New York City. Picture it dear girlfriends…. I began with a run in Central Park followed by breakfast at my hotel. Early morning was spent at the three major spiritual centres of worship (Saks Fifth Avenue, Bergdorf Goodman and Barney’s) followed by lunch at the Plaza hotel.

Feeling fashionably, physically and nutritionally nourished I thought my soul could use a pick me up and so I found myself standing in line at the Museum of Modern Art. I was having just a perfect day thus far and was looking forward to a little bit of French Impressionism to add to my day of Italian Footwear appreciation.

Just when I thought I would be all the better for this experience, the woman in front of me in line lit up a cigarette and began to puff away. Why must so many smokers always flaunt their habit? Is it that “bad girl image” she was trying so hard to uphold? Wan’t it this very “bad girl image” that got her smoking in the first place?

I know I have blogged once before about this “Butt”, however this bears a “second hand look” so to speak.

There she was some twenty something European tourist (she was speaking German and Europe seems to be the place to be if you are a smoker) literally blowing smoke up my ass and in my face.

Now, I am not a religious person, spiritual, yes, but religious no. I am rather shamefully proud of the shallow part of me that feels that Sunday brunch IS sacred and that Barney’s (the store, not the dinosaur ) is indeed a house of worship. All this being said, I believe I did in fact have a True belief in a higher power in that moment in line at the Museum of Modern Art. For there I was standing in the face of “cancer by proxy” and it started to rain.

And so my little German smoker who was blowing her Marlboro’s up and around for all in line to experience had not come prepared and was without an umbrella. She smiled at me sweetly as I promptly opened my big black “W Hotel” umbrella (on loan from the lovely concierge) and I smiled back waiting patiently for the downpour to wash away her cigarette’s ember, her unhealthy habits and of course her sins.

Moments later, her cigarette was soaked and she finally put the damn thing out. She looked over at me from her puddle of shame and like a little drowned cat with big sorrowful eyes she appealed to my sense of humanity,

“Do you have an extra umbrella?” she asked me. I think she asked me because I was literally staring at her grinning at my climatary luck, so speak.

And I opened my eyes equally wide in order to match her gaze and responded with a degree of mutual respect that was worthy of the situation.

“Nope.” I responded.

A few minutes of rain later, she soaked, me dry, the line moved and in we went to appreciate the works of this world’s masters.

Why did she have to smoke in line? If only she had walked away some 50 feet or so, had her cigarette and then come back to the line…. I would have been happy to share my umbrella with her.

But alas that was not the way it went down. I was not trying to teach a lesson, I was not trying to avenge. It was simple. I wanted that cigarette out and rather than ask this woman to put her cigarette out, I was going to allow Mother Nature to do my dirty work.

Make no mistake, dear girlfriends, I am NOT a heartless cow. I DO indeed care for the common man and woman. But, I love my lungs more than I love this stranger’s blow-out. Thus my umbrella, on this day was purely a table for one.

The interaction was a selfish one on my part…. But hey, she started it? Right?

Tobacco smoke contains more than 4,000 different chemical compounds, more than 50 of which are known to cause cancer. It is undeniable that smoking significantly increases one’s risk of developing a variety of cancers (including lung, breast and bladder) and heart disease as well as lung disease and stroke.

When you breathe in smoke that comes from the end of a lit cigarette, cigar, or pipe (sidestream smoke) or that is exhaled by a smoker (mainstream smoke), you're inhaling almost the same amount of chemicals as the smoker breathes in.

Further more, equally mounting evidence shows that second hand smoke increases a person’s risk of developing cardiovascular disease, lung disease and cancer. An estimated 50,000 Americans die each year as a result of second hand smoke.

According to the American Cancer Society, nonsmokers increase their risk of developing lung cancer by 20% when they are exposed to secondhand smoke.This equates to about 3,000 deaths annually from lung disease in nonsmokers caused by secondhand smoke exposure.

A review article published in Circulation in 2005 confirmed that second hand smoke increases a person’s risk of heart disease by about 30%. Furthermore, the study looked at all research on second hand smoke published from 1995-2005 and found that second hand smoke affect the cardiovascular system very much the same way that first hand smoke does. The evidence shows that the cardiovascular system—from blood vessel stiffness to atherosclerosis to oxidative stress, inflammation, heart rate variability, and energy metabolism, are all exquisitely sensitive to the toxins in secondhand smoke. The effects of even brief (minutes to hours) passive smoking are often nearly as large (averaging 80% to 90%) as chronic active smoking.Let’s be clear dear girlfriends, I was not spending hours training for triathlons because it was good for my personality. All that sweat and tears was not going to be flushed down the proverbial toilet just because some lovely German girl needed a “nic fit”.

And so yes it was very mean of me to leave one of my foreign sister “out in the rain”. It was cold and I was cold hearted. But I was putting my lung function before her well being and that was something I would have to live with.

Hours later wandering through the Impressionists’ hall at the MoMA my soul refreshed I took a long deep breath as I stood in front of Van Gogh’s famous Starry Night.

Inhale. Exhale. Inhale. Exhale.

It felt so good to breathe and the air was pure. I forgot about the rain and the smoke and noises in my head for just a moment and the world was new again.

Tuesday, October 12, 2010

Last week, Tuesday in fact, a car hit me. Yes Mother, if you are reading this, I never told you because somehow you would only worry and likely make some attempt to “forbid” your 40-year-old daughter from ever riding a bike. I was hit by a car while riding my bike.

Here’s the scene. I was making a right turn from a bike lane into a bike lane. A minivan (yes, my hate for the damn minivan is now deepened AND personal) came up from behind and side swiped me. My elbow made contact with their side view mirror (nice bruise to show for it) and I was knocked to the curb all in front of the Hermes store. Incidentally they were having a red carpet party (balloons and all) at Hermes that night and the lovely security guards out front were very helpful in getting me to my feet and making sure I was okay.

The van did not miss a beat and drove off. I too did not miss a beat and got back on my bike, made the right turn and rode up to the offending bullshit vehicle ready to let them know that in the cosmic scheme of things…. They were now on watch.

I took off on Lucy (my tangerine dream of a bike) and rode up to the van as it was parked at the next red light. Fueled by a sense of self righteous indignation I banged on the window.

Now understand please that I am now going to be mean. I was hit by a car, dear girlfriends, this should allow me at least 200 words of unjustifiable venom.

The driver of the car was not a real blonde. I myself have been dabbling in hair dye, but this woman had a platinum do that was just plain trashy. Think Jersey Shore not Marilyn Monroe. Further more, she had that really pastey pink lip stick thing going on that made her look like she was suffering from a wicked case of herpes and was putting some weird cream on her mouth to prevent an outbreak.

One final observation…. Her eyebrows had been plucked into near oblivion.

So when she pointed one of her shoddy acrylic nails at me and said with a bit of chuckle, “I barely saw you, you know.” I did in a moment of sisterhood feel a bit sorry for her lack of style.

Then I remembered that her lack of style had just hit me with her minivan and I recovered.

“Well, you hit me with your car.” I said.

“Well, you came pretty close to the car, you know.” This was from her boyfriendwho was riding shot gun. I could not help but notice his “What’s Jersey Wearing” homage to fashion complete with a fake tan and an ever popular tattoo art type t-shirt. And yes, my cybersisters, I lost my shit.

“Dude, (I did call him dude) are you insinuating that I hit your car with my bike?” Perhaps they did not understand what “Insinuating” meant, because they told me where I could shove my bike and proceeded to drive off.

Now, my beloved always tells me that I do have a bit of a horse-shoe up my backside. Well thank my lucky stars that riding in the car behind these upstanding citizens was an off duty police officer who in a good Samaritan move stepped out of his car and took down this lovely couples information in order to file a report.

I left the scene feeling a bit mournful for the future but with a renewed respect for our “boys in blue” and a renewed and more personal detest for minivans.

The left side of my body hurt like a mother-fun-house but nothing says pain killer like a cross to bare, a bone to pick and a cracked bicycle fender.

A week later, Lucy- my beautiful tangerine dream of a bike (you may remember her from a previous post) has survived the event and apart from some kick ass bruises which make me feel very butch, I am relatively unscathed.

A study published in the British Medical Journal in 1998 looked at data on 1462 injured bicyclists aged 1–19, obtained over a period of five years from the British Columbia Children's Hospital. Cycling injuries comprised 4% of all injuries seen in the five year study period. The proportion of admissions was 12.7% among bicyclists. Boys were injured more often than girls. The proportion of admissions for boys was 13.8% compared with 10.2% among girls. More than 70% of injured bicyclists reported no helmet use. The proportion of admissions of injured bicyclists who did not use helmets was two to four times higher than the proportion of admissions of those who used helmets. Head and face injuries occurred more often among those who did not use helmets. Of the 62 concussions, 57 occurred to non-helmet users.

You should know, I always wear a helmet. Firstly, it reinforces my need for an outfit. I have always maintained that a headpiece of any kind, will always tie a look together. Secondly, nothing says sporty and fit like holding your helmet once you’ve parked your bike somewhere safe. Finally, I have huge hair. When I am riding to work and back, the helmet tends to “tame my mane”. Fashion, sport good grooming and a statement piece…. It’s a process…. Nuff said.

According to a study published in the New England Journal of Medicine in 1989, bicycling accidents cause 1300 deaths each year in the USA. This is compared to 26,000 deaths from motor vehicle accidents. A case control study looked at the use of helmets in reducing head injuries among cyclist. According to this one year study, of the 99 cyclists with serious brain injury only 4 percent wore helmets. In regression analyses to control for age, sex, income, education, cycling experience, and the severity of the accident, the study found that riders with helmets had an 85 percent reduction in their risk of head injury and an 88 percent reduction in their risk of brain injury.

A further population study in the Journal of Trauma showed that bicycling accidents happen less frequently per capita in communities with a higher proportion of cyclists. In other words…. The more bicycles…. The safer.

Seven days later, several bruises (to my cycling mojo more than anything) and a new relationship with anti-inflammatories and I am a new woman/cyclist. Lucy has been to the bike shop and back with a clean bill of health. I have my guardian angel/off duty cop to thank for defending my honour.

To top it all off, I bought myself a new top of the line fabulous helmet. It’s light as a feather and strong as an ox…. All in the name of safety and science I found myself another statement piece. Life has a way of always working itself out.

Tuesday, October 5, 2010

Have you ever listened to women chatting while standing on line at apublic washroom? Well in the name of research I have on many occasions.As recently as this past weekend, in fact in New York City at a Broadway production of time stands still.

Let's be clear. Broadway is most definitely the shit. I saw some amazingtheatre that most definitely deserves the hype. The theatres however were built 50or so years ago when women apparently did not have to pee as much.

Perhaps they drank less? I can only surmise that portion sizes weredifferent back then and perhaps socially speaking we were conditionedto hold things in more.... Our opinions, our vote, our voice and yes,our urine.

An so there are only 4-5 stalls in each single washroom in any givenBroadway theatre. Well we now no longer hold anything back... Ouropinions fly freely. We vote, we hold offices of power and politicsand we drink venti americannos like they ate our life blood. Thus wepass urine as readily as we pass judgement.

And so the line up for the ladies washroom at this Broadway play waslong... I mean Oliver stone movie kind of long. It went down a flight ofstairs, across a powder room and into a small sub chamber towards 3stalls 2 sinks and some lovely smelling hand soap. I had spent thepreceding morning subsisting on coffee and retail and I had to pee.

I learned a lot in that line up of line ups.

I learned that all New Yorkers sound like they are my Jewish Aunt Ethel. This is due entirely to the stereotype that all Jewish women talk they are from NYC. But seriously (said in a Brooklyn twang and with a hand gesture) it’s true.

I learned that New York women as a rule have had a lot of work done. Forget California- this little island of Manhattan had more silicon than a Microsoft conference. Botox and Restylene and Juvederm, oh my! In a line up of 27 women I counted 12 sets of cheek implants, 8 face lifts (4 of them dreadful) and at least a dozen nose jobs. As for Botox- New Yorkers don’t smile much to begin with…. It was hard to tell…. But I would estimate double digits easily.

I learned that women talk in details. Mostly regarding their health and use terms like “They say….” To begin sentences where they want to convey a sense of authority. For example…. “Sally Hershberg had her spinal surgery, you know. She spent 4 hours in the operating room and another 2 hours in recovery. They operated on her face down and she had a puffy face for 4 days afterwards. They say she’ll be flat on her back for at least 3 months. She’s still going to try and host book club. We’re reading Lovely Bones again. I think it’s too depressing but the girls want to do it. They say you remember details better when you read a book twice.”

Most of all, I really wondered what is it about the female bladder? This was not the first time I had stood in a line somewhere in some theatre listening and waiting and holding it in.

I would leave, having emptied my bladder, having washed my hands and reapplied my lipstick and I would pass the entrance to the men’s room and of course… it was as empty as could be. In fact as a little girl I can remember going to the ballet with my parents. I can remember lining up at the women’s washroom at Winnipeg Concert Hall during intermission as the line snaked around the lobby. I remember glancing over to the men’s room and seeing men come and go in and out like bees to a busy hive without a delay or a care in the world.

It was only in those moments that I wanted so badly to be a boy. Do not worry- this passed as soon as I discovered the power of a good Handbag.

But I had to pause in this old theatre on this wonderful day amidst the women of Manhattan and wonder…. What the hell is with my girly bladder??

A study in the Journal of Urology published in 1991 had just the answer for me.

The study looked at urination among almost 700 patients. The patterns and frequency of daily urination were studied in 412 male and 244 female participants in the Baltimore Longitudinal Study of Aging. Men urinated less often (mean 4.8 voids per day) than women (mean 5.6 voids per day).

There was no main effect for age decade. However, an age by sex interaction showed that urination in men increased across the decades and in women it decreased.

Women in their 30’s urinate on average 6.2 times per day. Men in their 30s urinate 4.3 times per day. As people aged their bladders meet somewhere in the middle. In fact, men and women in the 70 and older age group had the same urination frequency of about 5 times a day.

In men frequency of urination was related to benign prostate enlargement and 2 of 4 symptoms of urinary obstruction (change in the force of the urinary stream and having to urinate again shortly after voiding).

In women a decrease in frequency was related to a lack of pregnancy complications. In other words, men peed more if their prostates were bigger and women peed less if they had easier pregnancies and less trauma to their urinary tracts during childbirth.

in both sexes frequency was unrelated to the reported daily ingestion of coffee, tea or diuretics, and no relationships were found with a history of an anxiety disorder.

And so I realized that by this argument the problem with a Broadway show was thirty something women who brought their bladders to the show.

Studies show that men and women have the same size bladders yet, women urinate more often due to the pressure of the uterus on the bladder causing less bladder control and retention.

Make no mistake…. I loved my Broadway experience, bathroom and all. I learned more in those lines than I did in some high school classrooms.

I’m now home safe back on the west coast where the women still pee like racehorse but talk like Canadians. I am comforted that the years will advance and my bladder will grow better so to speak as my male counterparts will eventually catch up to me,

I take comfort that my 70’s will be my great bladder equalizer. I will have to wait another thirty years in lines at washrooms while the men’s room remains relatively free….. until then…. I will always have Broadway.

About Me

Dr. Ali Zentner received her undergraduate medical degree from McMaster University and completed her Internal Medicine Residency with an extra year of Cardiology training at the University of Calgary. Ali has been practicing Internal Medicine since 2001 as a specialist in Cardiac Risk Management and Obesity. Ali is the author of The Weight Loss Prescription, published by Penguin books in 2013. It is the ultimate guide for healthy living and one hell of a book (no bias here). Ali also wrote A Good Life, a work of fiction, published in 2003. The novel has been best described as “Sex in the City” meets “ER” and details one woman’s struggle to find meaning in a world not always under her control. Both books are available on amazon.com. A classic overachiever, Dr. Zentner has completed the Vancouver marathon, and half marathons in New York, Vancouver and Toronto. She is an avid swimmer, runner and cyclist training for her next triathlon and who exercises to keep fit and to justify her next fashion purchase. She lives in Vancouver with her husband who says nothing about the size of his wife’s shoe closet (if he knows what is good for him)…